An Intraocular Pressure Of 98 Mhgm

This case recorded an extremely high IOP, which has not been previously reported in the literature.

Eye clinic

An elderly male in his 90s with severe learning difficulties was referred to the eye casualty department by his general practitioner following a visit to his care home, due to concerns of periorbital cellulitis involving his left eye. Past ophthalmic history included left eye phacomorphic glaucoma for which he underwent bilateral sequential cataract surgery in 2022. He previously had visual acuities of 6/12 in the right eye and longstanding no perception to light in the left eye. Past medical history included Dukes B colon cancer. IOP was 18mmHg in the right eye and 98mmHg in the left eye. There was left-sided cellulitis involving both upper and lower eyelids with yellow discharge, proptosis, expulsive haemorrhagic chemosis, 360-degree corneal neovascularisation and corneal oedema. The anterior chamber was flat with the iris abutted to the cornea and a non-reactive, mid-dilated pupil. There was a small inferior hyphaema, and the intraocular lens appeared brown-tinted, resembling an advanced brunescent cataract. A B-scan ultrasound revealed a large heterogeneous mass in the posterior segment. Differential diagnoses for the mass included suprachoroidal haemorrhage; choroidal metastasis; organised vitreous haemorrhage; or a new choroidal melanoma.

This case recorded an extremely high IOP, which has not been previously reported in the literature. It highlights the management options available for a patient presenting with a painful, blind eye. It also highlighted the challenges faced by patients with learning difficulties such as more advanced disease at the time of assessment, lower rates of screening, delays and difficulties in reaching a diagnosis, insufficiencies in communication and complex management choices. The Royal College of Ophthalmologists and Public Health England have published guidance on eye care for adults with learning difficulties.